Making Hospitals Speak the Language of Equity

At the age of 14, [Amal Abdulrahman was forced](/archives/2009/03/afraid_of_what_tomorrow_brings_1.html) to mind every painful detail of her father's cancer treatment. That's because the young Somalian girl was one of thousands of family members in Washington State who had to act as interpreters for ailing loved ones in hospitals lacking proper language services. Until recently, efforts to get quality medical interpreters to patients that need them in Washington State were stymied by budget concerns--interpreting brokerage firms, who draw hefty fees for placing workers, drove up the costs. But what if you could cut out the costly middlemen, improve the working conditions of medical interpreters themselves and thus improve the quality of care that patients receive? Does that make too much sense to be real? The people at Washington Community Action Network and the Federation of State Employees didn't think so. And on April 20, Washington State Gov. Chris Gregoire [signed a bill](http://nwfco.org/966/wa-can-medical-interpretation-empowers-patients-and...) that eliminated the contracting of brokerage firms, allowed medical interpreters to bargain for wages and benefits with the governor and thus cleared the way for more accessible health care for everyone in the state. Of course, [there's a lot more to this story](/archives/2009/04/were_sick_of_not_being_heard_r.html). But at the heart of it is the dogged pursuit of quality healthcare for everyone. Yes, everyone. The fact that our healthcare system leaves a lot of people out in the cold hasn't gone unnoticed. A recent [report by the Commonwealth Fund](http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/M...) found that the U. S. healthcare system ranked last in access, patient safety, coordination, efficiency and equity, when compared to other developed countries, including Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom. The Fund found that the U.S. scored lowest on nearly all measures of equity. And equity is where the rubber hits the road. Equity is about fairness, about ensuring that everyone gets their needs met. So, for example, when equity is in play a 20-year-old athlete, a middle-aged woman and a newborn baby would not be fed the same dinner. Serving individualized meals of pasta, a beet salad and breast milk would better meet their specific nutritional needs. A system that is blind or indifferent to these needs feeds the poor and communities of color gruel, while others get steak and potatoes. The report defines equity as "providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status." If you want to improve the quality of healthcare you have to name the problem, then take action to change it. Do we really want everyone to be healthy? Then we have to recognize that some of us need a hospital that is on a major bus route or a doctor that takes Medicaid patients or services that take into account cultural differences. The state of healthcare in the U.S. is a perfect example of what you get when you starve a system of equity: death. Take yet another [study published by the Journal of the American Medical Association](http://www.med.unc.edu/www/news/unc-study-helps-explain-why-black-patien...) that found that Black patients that are diagnosed with lung cancers are less likely to opt for surgery in the early stages than whites. This is unsettling, considering that Blacks have the highest death rate of any racial and ethnic group for most cancers. Further findings point out that "Black perceptions of physicians as uninterested and less engaging lead to fewer adherences to physician recommendations and inadequate understanding of treatment problems." You could almost draw straight line to the Fund's equity indicators that show that many of the most vulnerable patients in the U.S. forgo recommended tests and treatments. The Fund report takes the relevance of equity even one step further in terms of what it means for the recently passed national health care law:

These results indicate a consistent relationship between how a country performs in terms of equity and how patients then rate performance on other dimensions of quality: the lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen. Rather than disregarding performance on equity as a separate and lesser concern, the US should devote far greater attention to seeing a health system that works well for all Americans. The US has passed historic legislation that promises to improve health insurance coverage and quality of care for low and moderate-income families. This is an important first step, but the nation must remain vigilant about monitoring the experiences and outcomes of vulnerable populations. In doing so, it can continue to make progress toward a high performance health system that can truly be called "the best in the world."

As the Washington State experience with translators has shown us, we can end racial disparities in healthcare. There are solutions. Cutting out the fiscal waste from profit-driven entities is a solution. Valuing healthcare workers is a solution. The training of culturally competent patient advocates who bridge trust-divide between doctors and patients is a solution. There are many solutions. But when people speak up and demand that everyone get their needs met, that is the ultimate solution.